Introduction The Society for Acute Medicine (SAM), the representative body for professionals working in Acute Internal Medicine (AIM) across the UK, welcomes the opportunity to respond to NHS England’s Medical Training Review. Acute Medicine lies at the heart of the NHS, delivering high-quality, time-sensitive care for acutely unwell patients and playing a crucial role in patient flow, workforce resilience, and system capacity.
As a body committed to excellence in training and patient care, SAM strongly advocates for improvements to postgraduate medical training that support both the well-being of resident doctors and the needs of patients. In this submission, we present our evidence-based recommendations focused on the sustainability, accessibility, and equity of medical training across the UK.
1. Better Workforce Planning: There is an urgent need for more accurate and proactive workforce planning. Shortfalls in medical staffing have placed immense pressure on acute services and have directly affected training quality. Current modelling must be replaced with dynamic, real-time workforce intelligence to anticipate future needs and align training numbers accordingly.
2. Expansion of Training Posts: The expansion of training numbers must be a central pillar of workforce strategy. Acute medicine, in particular, has historically struggled to attract sufficient resident doctors. Expanding core and higher specialty training posts will not only support service delivery but also provide career sustainability for future consultants (HEE, 2022).
3. Equitable Distribution of Training Posts: We call for equitable and data-informed allocation of training posts across geographic regions to reflect patient demography and healthcare needs. Disparities in training opportunities between urban and rural areas contribute to unequal service provision and exacerbate workforce shortages in underserved communities (BMJ, 2020).
4. Minimise Disruption from Rotational Training: Rotational placements often require resident doctors to relocate significant distances multiple times during their training. This disrupts continuity of life and adds financial and emotional burdens. Deaneries must aim to design rotations that are geographically compact and consider personal circumstances, in line with NHS People Plan values (NHS, 2020).
5. Flexibility in Training: We urge NHS England to simplify the application process and expand access to Inter-Deanery Transfers (IDTs) and Less Than Full Time (LTFT) training. Bureaucratic hurdles and inconsistent implementation discourage applications and undermine morale. Streamlining these processes supports retention, particularly for those with caring responsibilities or health needs (GMC, 2023).
6. Implementation of Self-Development Time (SDT): The introduction of SDT is a vital recognition of the need for protected time to pursue academic and developmental activities. However, its inconsistent delivery across the UK undermines its purpose. Enforcement of minimum SDT standards is essential, and local education providers must be held accountable.
7. Access to Study Funds: There must be transparent and timely access to study budgets. Resident doctors report widespread variation in access and significant delays in reimbursement. A centralised, simplified platform for applying and tracking study budget claims would improve fairness and usability.
8. Simplifying Study Leave Processes: Barriers to accessing study leave—especially at short notice—must be reduced. Processes should be digitised and standardised nationally. Where service cover allows, default approval for deanery-approved events should be considered.
9. Empowering Medical Training through Skill Expansion: Acute and General Medicine must be empowered to manage patients holistically and perform core procedures. Training opportunities should routinely include point of care ultrasound, pleural procedures, ascitic paracentesis, midlines and central venous lines, and lumbar punctures, among others. Empowering generalists in this way improves patient flow, avoids unnecessary referrals, and builds clinical confidence (SAM, 2021).
10. Financial Support for Resident doctors: Current financial support mechanisms are inadequate given the cost of training, relocation, exams, and professional requirements. Deaneries should appropriate financial support to help meet the cost of training and cover relocation expenses for mandated rotations.
11. Academic Access and Support: Support for academic development is essential to nurture the next generation of clinical leaders. Funding routes for fellowships, postgraduate degrees, and leadership courses should be more widely available and accessible regardless of region. Partnerships with NIHR and HEE could facilitate equitable access to academic opportunities (NIHR, 2022).
12. Addressing On-the-Job Pressure and Staffing Shortages: High patient acuity combined with inadequate staffing has led to unsafe workloads and burnout. Improving workforce management, ensuring adequate consultant and junior cover, and introducing team-based staffing models will enhance both patient care and training experience (RCPL, 2023).
13. Better Rotas and On-Call Frequency: Resident doctors frequently report rota patterns that are unsustainable, with excessive frequency of night shifts and on-calls. Rota design should ensure appropriate rest, fair distribution of duties, and protected leave to maintain health and well-being (BMA, 2022).
14. Equitable Provision of Training across Protected Characteristics: Training provision must actively reflect and accommodate the diverse profile of the medical workforce, including variation in race, ethnicity, gender, disability, and other protected characteristics. Differential attainment remains a significant concern, and training programmes must address it proactively through inclusive design and equitable support systems (GMC, 2023).
15. Tailored Support for Resident doctors in Difficulty: Medical training must incorporate robust mechanisms to identify and support resident doctors experiencing difficulties, whether related to academic performance, health, or personal circumstances. Tailored, individualised support pathways should be embedded within training structures to ensure no resident doctor is left behind.
16. Supporting Trainers and Educational Supervisors: Equally essential is ensuring that trainers and educational supervisors are equipped to deliver high-quality training. Trainers must be given adequate time within their job plans, on-going faculty development opportunities, and appropriate institutional support. This enables them to offer meaningful, consistent supervision and mentorship that is critical for resident doctor development and well-being.
17. Continuous Review and Innovation in Training Content: Training programmes must be subject to regular review to ensure they remain aligned with the fast-evolving landscape of modern medicine. Innovations in clinical practice, technology, and models of care must be swiftly integrated into training curricula to ensure resident doctors are well-prepared for contemporary healthcare demands.
18. Timely Adaptation to Resident doctor Feedback: Resident doctor experience and feedback must be actively reviewed, and mechanisms should be in place to implement necessary changes in a timely fashion. Rather than slow and bureaucratic processes, we call for more agile and responsive adaptations to training programmes in line with the lived experiences of current resident doctors.
19. Supporting Return to Work: Returning to training after a period of leave—whether for parental, health, academic, or personal reasons—requires tailored support. Structured phased returns, access to breastfeeding rooms and milk storage facilities, and the option for flexible shift patterns should be widely available. This is essential not only for new parents but for any doctor re-entering training. A compassionate and practical approach to return-to-work planning helps resident doctors rebuild confidence, reintegrate into clinical environments, and continue their professional development without unnecessary barriers.
Conclusion – Commitment to Resident doctor Well-being and Welfare: The training system must prioritise the well-being of resident doctors as a central tenet of its structure. Preventing burnout, ensuring a positive and enjoyable training experience, and fostering a supportive environment are critical. Resident doctor welfare and patient safety must go hand in hand. All forms of clinical, psychological, and pastoral support should be available and easily accessible to ensure that resident doctors can thrive throughout their professional development.
The Society for Acute Medicine reaffirms its commitment to high-quality, equitable training that supports the well-being of the medical workforce and the safety of patients. We urge NHS England to act on the evidence presented and implement reforms that make training more sustainable, inclusive, and empowering for the doctors of tomorrow.
References
- Health Education England (HEE). “Future Doctor Programme Report.” 2022.
- British Medical Journal (BMJ). “Uneven Distribution of Training Posts.” 2020.
- General Medical Council (GMC). “National Training Survey 2023.” 2023.
- Society for Acute Medicine (SAM). “Position Statement on Procedural Training in AIM.” 2021.
- National Institute for Health Research (NIHR). “Academic Clinical Fellowships.” 2022.
- British Medical Association (BMA). “Fatigue and Rota Design Guidance.” 2022.
- NHS England. “NHS People Plan.” 2020.